Select Page

Eccentric or concentric exercises for tendons? That is the question.

14th Nov, 2022

Key Points

  1. Exercise is a popular mode of management for tendinopathy conditions and provides good clinical outcomes
  2. Loading programs as a treatment yield positive clinical, structural, and biochemical outcomes
  3. Isolated eccentric exercises are a popular treatment regime but there is no firm evidence to prove it is the best loading program

What does the science say: eccentric or concentric loading? 

The tendons in our body are what connect muscle to bone. They play an important role in allowing us to produce movement and are hence built to withstand heavy loads. Tendinopathy occurs when we load a tendon repetitively without giving it a rest, and is characterised by pain during activities such as jumping or running. While many interventions exist today for this condition, the best supported one is a loading intervention. Many versions of loading interventions have been proposed, but the most popular one is an isolated eccentric loading paradigm. More recently, new loading-based programs have been emerging. So how do we choose the best one? Lets focus on the underlying rationale of all these loading paradigms.

What are eccentric and concentric exercises? 

Exercises can be divided into 2 groups, eccentric and concentric exercise. Eccentric exercises refer to lengthening of the muscles, and concentric exercises refer to shortening of the muscles. Imagine you’re going up and down the stairs. The act of going up the stairs is a concentric movement whilst going down is an eccentric movement.

Lunges as a concentric exercise for patella tendinopathy
Ankle sprain assessment and treatment Singapore by The Rehab Centre
Single leg squat as an eccentric exercise for patella tendinopathy

Is there a difference? Why consider these types of exercises?

Between eccentric and concentric exercises, muscles produce more force eccentrically than concentrically. This would suggest that eccentric exercises can provide greater mechanical stimulation. It has also been suggested that the tendon stretches more with eccentric loading than concentric loading.

With eccentric muscle contraction on the achilles tendon, studies have shown that eccentric loading programs give better clinical improvements such as reducing pain and improving function. Studies on eccentric muscle contraction of the patellar tendon suggest likewise as well. However, there is no firm evidence to support that eccentric loading is more efficient than other loading regimes such as concentric loading

If the science if unclear…what can we do?

Despite how common tendinopathies occur in athletes, there is still a lot we don’t know about its onset. However, there are a variety of  treatment options of which loading regimes have shown to give good clinical results. Even though there is no firm evidence to decide which loading regime is most effective, or if an eccentric loading-based regime is the best program for tendinopathies, a common theme in all the loading programs is that they focus on loading the tendon to increase its tolerance. However, tendinopathy rehabilitation is not just about eccentric or concentric exercises and should not overshadow other aspects of the rehabilitation program. 

What are some exercises for tendinopathies?

Rehabilitation for patellar tendinopathy is focused on introducing and progressively increasing load tolerance on the patella tendon. Some exercises such as eccentric single-legged squats on a decline board, hack squats, or leg presses could be a good start for patellar tendinopathy pain, whereas for the achilles tendon, a common eccentric exercise is the standing heel lowering. 

Do take caution not to exceed your load tolerance as that would be detrimental to your progress. It is also important to emphasise that experiencing some pain before and after doing these exercises is acceptable as long as the symptoms resolve themselves fairly quickly rather than continue to get worse over the course of rehabilitation.

Why is Physiotherapy important in the management of tendinopathies?

Patellar tendinopathy rehabilitation can be complex in terms of knowing when to increase load tolerance or introduce a new set of exercises. It is important not to rush into overloading the tendon as it diminishes the effects. Similarly, underloading the tendon will not give the desired outcome either. It is best to consult a therapist who understands when to progress the stages of rehabilitation better, and work together in order to return to sport and prevent re-injury.

Unsure of what to do? Contact us to speak to our Physiotherapist who will be able to ascertain the source of pain and have it addressed early!

DISCLAIMER: These advice and exercises should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.

Ref: 

Couppé, C., Svensson, R. B., Silbernagel, K. G., Langberg, H., & Magnusson, S. P. (2015). Eccentric or concentric exercises for the treatment of tendinopathies? Journal of Orthopaedic & Sports Physical Therapy, 45(11), 853–863. https://doi.org/10.2519/jospt.2015.5910

Share Post:

Latest Posts

The hip and foot can affect patella tendon pain?!

The hip and foot can affect patella tendon pain?!

Key Points Patellar tendinopathy is an overuse injury that occurs more often in elite athletesImpairments of the hip and foot/ankle are associated with patellar tendinopathyReduced hip internal range and weak hip abductors may contribute to patellar tendinopathy What...

Low back surgery done. Can I do Pilates?

Low back surgery done. Can I do Pilates?

What is Pilates? Pilates is a form of exercise and body conditioning developed by Joseph Pilates in the early 20th century, during his stint as a nurse in World War I where he experimented attaching springs to hospital beds in order for the injured soldiers to still...

What is patellar tendinopathy, and can I get better?

What is patellar tendinopathy, and can I get better?

Key Points Patellar tendinopathy is recognised by pain in the front of the knees, and when too much loading on the kneesThe best form of management is through exercisePatellar tendinopathy rehabilitation can be slow and frustrating. While there are no shortcuts, make...

Tendinopathies. A brief.

Tendinopathies. A brief.

Key Points Tendinopathy refers to a non-rupture injury in the tendon, whereas tendonitis refers to inflammation in the tendonTendinopathy develops from repetitive overuse of the tendon before it has fully healedDiagnostic imaging is a useful tool to visualise the...

Front of knee pain. What helps and what does not.

Front of knee pain. What helps and what does not.

Key Points Patellofemoral pain is a common knee condition that affects all ages and lifestyles. It is more prevalent in females, especially those who have weaker quadriceps strength, and participate in a single sport. Patellofemoral pain is aggravated by activities...

Exercise vs Surgery for a degenerative meniscal tear. Yay or nay?

Exercise vs Surgery for a degenerative meniscal tear. Yay or nay?

Key Points Patients with degenerative meniscus tears and no radiographic evidence of OA should consider exercise therapy over surgery. There is no clinically relevant difference between exercise and surgery for a degenerative meniscal tear. Supervised exercise therapy...

Ultimate frisbee? My foot!

Ultimate frisbee? My foot!

Ultimate frisbee in Singapore Yes Ultimate Frisbee is a great sport and growing sport in Singapore! It’s loads of fun competitively, or even just as a casual game. However, like all sports, there is some risk of injury to the feet involved with Ultimate Frisbee. There...

Gold standard for the management of degenerative knee conditions?

Gold standard for the management of degenerative knee conditions?

Key Points There is a strong recommendation against knee arthroscopy surgery in patients with degenerative knee disease. Surgical management is not practical due to its minute improvement in pain.   Arthroscopic surgery and conservative management of knee degeneration...

What are the common causes of chronic ankle pain?

What are the common causes of chronic ankle pain?

Our amazing ankles Our ankles are highly complex anatomical structures. They are very stable because of the structure of the bones and anatomy involved, but yet is required to be mobile to absorb shock and adapt to the surfaces that we walk on everyday. However,...

What type of exercises are useful for front of knee pain?

What type of exercises are useful for front of knee pain?

Key Points Weakness in the hip muscles is one contributing factor to patellofemoral knee pain. Hip and knee strength exercises are more effective in reducing pain and improving activity in individuals with patellofemoral pain than knee strengthening exercises alone....